Citation Nr: 21002035 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 15-00 569 DATE: January 12, 2021 REMANDED Entitlement to service connection for right lower extremity (RLE) neurological disability, to include peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1963 to December 1967 in the United States Army. The Veteran has qualifying service in Vietnam from May 13, 1965 to May 13, 1966. His exposure to herbicide agents is presumed. This appeal comes before the Board of Veterans’ Appeals (Board) from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, September 2019, and August 2020, the Board remanded the claim for further development. Unfortunately, remand is again required as there has been substantially compliance with the prior remand directives. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268, 271 (1998); Dyment v. West, 13 Vet. App. 141 (1999). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38U.S.C. §7107(a)(2). Entitlement to service connection for RLE neurological disability, to include peripheral neuropathy is remanded. The Veteran contends that his RLE neurological disability stems from his service in Vietnam. In this regard, the Veteran argues that his disability is related to in-service exposure to herbicide agents. See VA Form 9 (June 2017) & NOD (August 2015). The Veteran’s representative has not raised any particular argument or contention. For reasons explained below, the Board finds that remand is necessary. Pursuant to an August 2020 Board remand, the RO obtain an addendum VA medical opinion (VAMO) dated in October 2020. The October 2020 VAMO reflects that the Veteran has peripheral neuropathy of the RLE and that he does not have radiculopathy of the RLE. The VAMO dismissed the Veteran’s lay reports of in-service and post-service neuropathy symptoms because (1) of the lack of medical documentation and (2) neuropathy symptoms are “not easily dismissed or ignored by patients, especially for 30 years.” The opinion, in this instance, considered the Veteran’s lay reports and contentions as requested by the Board’s prior remand, but found them not credible or unpersuasive because of the lack of medical documentation (in-service and post-service), and because his reported symptoms would not be easily ignored and thus be associated with contemporaneous medical evidence due to their severity. Additionally, the opinion noted that trauma caused by parachute jumps would result in radiculopathy and not peripheral neuropathy, and that Veteran’s neuropathy, of post service onset, is not at least as likely as not related to in-service injury or disease referencing medical literature. In this case, the October 20202 VAMO remains inadequate to decide this appeal. Pursuant to Bailey v. O’Rourke, 30 Vet. App. 54, 60 (2018), a medical rationale based solely on general medical literature without discussing the specific facts pertaining to a veteran’s condition or individual circumstances is inadequate. Here, the VAMO quoted the following findings from medical literature: (1) A large proportion of neuropathies have an unknown etiology, and 24% of all peripheral neuropathies are attributed to drugs or toxins; (2) Most symptoms have an insidious onset or occur very shortly after exposure with few exceptions. (See https://now.aapmr.org/peripheral-neuropathies-associated-with-drugs-and-toxins/). Although the opinion identified the medical literature, it does not reveal that facts specific to the Veteran vis-à-vis the medical literature were discussed. Indeed, it does not explain or elaborate on the quoted portion of the medical literature; this is significant considering that herbicide agents could be considered “toxins” and “24% of all peripheral neuropathies are attributed to drugs or toxins.” Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21Vet. App.303 (2007). Accordingly, given that the VA medical opinion is inadequate for decision making purposes, the Board finds that remand is necessary. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran’s assertions. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: 1. Obtain all VA treatment records dated from August 2020 to the Present. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s RLE neurological disability, neuropathy. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. The clinician should opine on: (a) Whether it is at least as likely as not that the Veteran’s RLE neurological disability, neuropathy, is due to or the result of in-service injury or disease, to include (i) exposure to herbicide agents and/or (ii) hard paratrooper landings. Explain. (b) Whether it is at least as likely as not that the Veteran has “early onset” peripheral neuropathy of the RLE; and if so, whether it manifested to a degree of 10 percent disabling within one year of herbicide agent exposure. Explain. The medical opinion should, at a minimum: (a.) Reflect consideration of (i) the documented history; (ii) the lay contentions (e.g. RLE neurological disability was caused by in-service exposure to herbicide agents, parachute jumps); and (iii) relevant medical evidence of record. (b.) Identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). NOTE: (1) An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints; (2) Reliance on the absence of medical literature supporting nexus without discussing the specific facts of the case renders an opinion inadequate. 3. Ensure that the VA medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. A. Macek, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.